手术切口感染相关危险因素分析

目的 对医院手术室患者切口感染相关危险因素进行分析,为制定预防控制管理措施提供参考依据.方法 回顾性分析医院2011年收治的3875例手术患者临床资料,对手术切口感染相关危险因素进行分析,并与采取预防控制管理措施后2012年手术切口感染率进行比较分析.结果 2011年共有79例患者出现切口感染、切口感染率为2.04％;单因素分析结果显示,年龄在21～50岁、骨科患者、手术时间＞5h、术中发生失血、手术切口长度＞10 cm、Ⅲ类手术切口、住院时间＞10 d、肥胖患者、留置引流管是手术患者发生切口感染的相关危险因素(P＜0.05);共检出病原菌98株,其中革兰阴性杆菌74株占75.51％,革兰阳性菌24株占24.49％;2012年手术切口感染率为1.02％,显著低于2011年感染的发生率2.04％(x2=14.312,P＜0.05).结论 根据相关危险因素制定针对性地预防控制管理措施,增强预防意识,加强培训考核;完善各种规章制度规范,加强手术室感染控制管理;合理应用抗菌药物,降低耐药性.     

压力蒸汽灭菌工作的管理

随着我国医疗卫生事业的发展，微生物学、流行病学，生物化学等学科迅速向纵深发展。一方面灭菌工作提供了理论基础，另一方面也给感染控制工作者提出了新的要求。现将我院如何进行压力蒸气灭菌工作的管理浅述如下。     

一种新型空气消毒机消毒净化效果及杀菌因子的实验研究

目的研究一种新型空气消毒器的消毒净化效果及杀菌因子。方法采用空气消毒模拟现场试验和现场试验检测空气消毒效果,采用仪器法检测消毒后的尘埃粒子数,检测杀菌因子紫外线辐照强度和等离子体等,检测紫外线和臭氧泄漏。结果该空气消毒器作用45min对20m3房间内人工喷染的白色葡萄球菌杀灭率99.9%;作用90min对空气中自然菌的杀菌率90%;在一定区域内对尘埃粒子有净化作用。该消毒机能产生密度中等的电晕放电等离子体,安装的紫外线灯管辐照强度为48.4μm/cm2,没有紫外线和臭氧泄漏。结论该空气消毒器依靠紫外线与等离子体的协同作用有良好的空气消毒效果,能在有人状态下使用。     

Nutrition status and risk factors associated with length of hospital stay for surgical patients

Objective: To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS). Methods: The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi‐square test was used to compare proportions, and the Mann‐Whitney or Kruskal‐Wallis test was used to compare continuous measures. Linear association was verified using Spearman's rank correlation coefficient. Cox's regression model was used to investigate factors associated with LOS. Results: Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well‐nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7–6.2]) than those who had some degree of malnutrition. Well‐nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1–5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0–1.1]). Conclusions: LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.     

Immunogenetic factors associated with type 1 diabetes mellitus

Type 1 diabetes mellitus has been considered an organ-specific autoimmune disease derived from the selective destruction of pancreatic beta cells. It presents a complex pathogenesis, involving the participation of several factors, including the immunogenetic susceptibility with strong association to histocompatibility genes (HLA), environmental events and autoimmune response with the presence of autoantibodies and/or autoreactive lymphocytes, culminating in metabolic abnormalities. In this study, the literature review describes mechanisms through which some factors cause susceptibility to its appearance and, additionally, prediction innovations regarding this disorder, which will certainly contribute to nursing care for patients with type 1 diabetes.     

我国女性绝育时机及其选择影响因素分析

目的:分析我国女性绝育时机的选择及其影响因素。方法:利用《2006年全国人口和计划生育调查》数据,对其中8201名妇女的绝育时机进行单因素和CHAID多因素分析。结果:产后0~3个月绝育比例为48.3%,不同特征人群存在统计学差异(波动范围30.4%~87.3%)。最后一次活产分娩方式、采取绝育年份、决定绝育者、民族、受教育程度是影响绝育时机的重要因素。结论:女性绝育时机的选择应当作为知情选择的具体内容进行宣传,我国女性绝育的时机还有待于进一步优化。     

Risk factors associated with senile dementia of the Alzheimer's type

Significant cognitive impairment affects approximately 15 percent of the U.S. population over age 65. The most prevalent form of irreversible dementia is senile dementia of the Alzheimer's type (SDAT), which accounts for at least 50 percent of nursing home admissions and roughly 10 billion dollars a year in health care costs. In spite of the social, economic, and medical impact of the disease, epidemiological data are scarce concerning risk factors associated with the disease. Until recently, most of the population-based studies of senile dementia in the elderly were carried out in Northern European countries. The methodological problems that arise in performing epidemiologic studies on SDAT may in part explain the lack of sufficient data pertaining to certain risk factors. This paper provides a review of the literature and research on risk factors in dementia in the elderly and discusses directions for future research. The epidemiological issues associated with certain key studies are also discussed. Although the major studies that have attempted to look at risk factors in mental illness in the elderly are beginning to fill in some of the gaps in the understanding of the etiology and epidemiology of the disease, further epidemiologic studies on both institutionalized and community-based elderly populations are needed. These should assess a wide range of possible factors (demographic, psychological, environmental, health practice, and medical) in terms of their association with SDAT. By developing a comprehensive epidemiologic profile of SDAT, possible preventive measures and therapeutic approaches to treating the disease may be identified and hypotheses for future epidemiological and laboratory investigations developed.     

等离子体灭菌运行过程与常见故障

等离子体灭菌器使用过程中常会遇到各种各样的故障。首先介绍了等离子体灭菌器的基本原理,观察其在正常条件下的运行过程,重点介绍常见故障的原因,以便及时发现和排除。     

医院消毒供应中心手术器械的清洗消毒和管理

目的：提高医院消毒供应中心的感染控制及管理水平。方法：医院消毒中心建立清洗消毒标准化的工作流程,从器械回收、器械清洗、清洗洁净度检查、器械包装、器械灭菌及发放等细节入手,加强质量监测,注重人员培训和部门科室之间的沟通协调。结果：医院感染控制管理水平及成效得到明显提高,实现了资源整合,节省了各相关科室清洗消毒设施的投资和运营成本,避免了手术器械对工作人员及周围环境的再次污染。结论：所采取的感染控制及管理措施切实可行,并富有成效。     

外科手消毒规范执行过程中存在的问题及管理对策

目的 进一步规范、统一海南省外科手消毒操作与监督管理.方法 2010年5月对海南省6所三级甲等医院外科手消毒规范执行现状进行调查,将执行过程中存在问题进行汇总、分析,制定相应管理对策.结果 该次调查中,仅1所医院制作图文并茂的外科手消毒指引;内容包括洗手前着装要求、外科手消毒流程、关键步骤示意图等,使手术人员对该项调查的满意度由75.24％提高至92.63％.结论 建议各医院强化管理力度、提高外科手消毒质量,以保证手术患者安全.     

Dyslipidemia and its associated factors in patients with type 2 diabetes mellitus

Journal of Public Health - Dyslipidemia is a major risk factor known to be associated with diabetes and cardiovascular diseases. This study determined the frequency of lipid abnormalities among...     

体外膜肺氧合术后患者医院感染危险因素分析

目的了解接受体外膜肺氧合（ECMO）治疗患者术后发生医院感染情况,并分析相关危险因素。方法收集某院2003年1月-2012年12月应用ECMO辅助治疗患者的病历资料进行回顾性分析。结果43例接受ECMO治疗的患者术后发生医院感染15例（34.88％）,24例次（55.81％）。医院感染部位以下呼吸道（12例次,50.00%）为主;其次是血液系统（6例次,25.00%）、皮肤和软组织（5例次,20.83%）等。分离病原体28株,其中革兰阴性杆菌19株（67.86%）,革兰阳性球菌7株（25.00%）,真菌2株（7.14%）;主要分离自痰标本（12株,42.86%）,其次为血标本（9株,32.14%）和伤口分泌物标本（6株,21.43%）等。ECMO治疗患者术后医院感染的发生与患者年龄、ECMO辅助时间、并发症、呼吸机辅助呼吸、气管插管或切开、留置导尿管有关。结论接受ECMO治疗的患者术后医院感染率较高,医院应针对相关感染危险因素,采取有效的预防控制措施,减少ECMO术后医院感染的发生。     

慢性重型乙型肝炎患者医院感染特点及危险因素

目的探讨慢性重型乙型肝炎患者医院感染的临床特点及危险因素,为预防与控制其医院感染的发生提供理论依据。方法采用回顾性调查方法,调查某院2012年1月-2015年1月的慢性重型乙型肝炎住院患者的医院感染发生情况,并对其医院感染的危险因素进行分析。结果共调查126例慢性重型乙型肝炎患者,发生医院感染49例,106例次,医院感染发病率为38.89%。医院感染部位以呼吸道为主（47例次,占44.34%）,其次为腹腔（34例次,占32.08%）。共检出医院感染病原菌76株,其中革兰阴性菌41株（53.95%）,革兰阳性菌33株（43.42%）,真菌2株（2.63%）。患者年龄≥60岁、住院日数≥30 d、 合并并发症、侵袭性操作、血清清蛋白＜35 g/L、白细胞＜4×109/L是慢性重型乙型肝炎患者发生医院感染的危险因素。结论慢性重型乙型肝炎患者医院感染发病率较高,以呼吸道及腹腔感染为主,年龄较大、住院时间长、侵袭性操作、低蛋白血症及血白细胞低均是其医院感染的危险因素。     

Interleukin-2 and dendritic cells as adjuvants for surgical therapy of tumours associated with human papillomavirus type 16

Moderately immunogenic HPV 16-associated tumours TC-1 (MHC class I(+), HPV 16 E6/E7(+), G12V Ha-ras(+)) and MK16/1/III ABC (MHC class I(-), HPV 16 E6/E7(+), G12V Ha-ras(+)), both of the H-2(b) haplotype and transplanted in syngeneic mice, were used to examine the adjuvant effects of IL-2 and dendritic cells for surgical therapy. Mice were inoculated s.c. with the respective tumour cells, and when the tumours reached 8-12 mm in diameter, they were extirpated. Three days after surgery, the experimental mice were treated with IL-2, IL-2 gene-modified tumour vaccines, or dendritic cells, injected s.c. to the site of previous surgery. It has been found in both, MHC class I(+) and MHC class I(-) tumours that the recombinant IL-2 and IL-2 gene-modified vaccines substantially reduced the tumour recurrence rate and inhibited growth of tumour recurrences. The dendritic cells were significantly effective only in mice with surgical minimal residual TC-1 (MHC class I(+)) tumour disease and when injected before they have reached the terminal stage of their differentiation.     

Medical and surgical therapies for pain associated with endometriosis

Endometriosis is a common condition for which a number of treatments have been proposed. Medical treatments are based on the hormonal responsiveness of endometriosis implants. These therapies include progestins (with or without estrogens), androgens, and gonadotropin-releasing hormone (GnRH) analogs. Surgical treatments may include hysterectomy with oophorectomy or organ-sparing surgery involving ablation or resection of visible lesions of endometriosis and restoration of pelvic anatomy. There are no studies that directly compare the effectiveness or adverse effects of medical therapy and surgical therapy. Studies on medical therapy compare different treatments with placebo or with other active treatments. Hormone-based therapies for endometriosis show 80%-100% effectiveness in relief of pelvic pain over a 6-month course of therapy. Serious adverse outcomes after medical therapy are unusual. Studies on surgical therapy are largely anecdotal, with noncomparative reports on a variety of surgical methods. A few comparative surgical studies have been reported. Because of the noncomparative nature of many of the surgical studies, the use of combinations of surgical procedures and techniques in the reported studies, and the reporting of results from surgeons with an unusually high level of technical skill, the gynecological practitioner has little basis in the literature for assessing the optimum surgical approach. Surgical complications are believed to be underreported and may be related to how aggressive a surgical procedure is undertaken.     

Tip proteins of pili associated with pyelonephritis: new candidates for vaccine development

Escherichia coli strains associated with extra-intestinal infections frequently express carbohydrate binding adhesins which are present as minor components of pili. The adhesin protein, PapG, and at least two other minor pilus subunits, PapE and PapF, are associated with the tips of Gal alpha (1-4)Gal-binding Pap pili or P fimbriae of uropathogenic E. coli. The structural and antigenic variation of these tip-associated proteins is discussed and evidence is presented showing that serologically identical pili may contain antigenically distinct adhesins each capable of binding to a specific receptor. One approach to the purification of these tip-associated proteins is presented and involves complex formation with the periplasmic transport protein PapD.     

Epidemiology and risk factors associated with surgical site infection following surgery on thoracic aorta

Surgical site infection (SSI) following cardiovascular surgery has been well documented, possibly owing to its highly invasive nature, but SSI following surgery on the thoracic aorta has not. This study aimed to describe the epidemiology and assess risk factors associated with the latter in Japan using a national database for SSI. Data on surgery on thoracic aorta performed between 2012 and 2014 were extracted from the Japan Nosocomial Infections Surveillance (JANIS) database. Risk factors were assessed initially by univariate analysis, and then entered into a logistic regression model for final evaluation. The cumulative incidence of SSI was 4.1% (146/3538) and staphylococci were the most frequent pathogens isolated. Factors such as the duration of operation, emergency surgery and male gender were significantly associated with SSI. These findings differ from previous studies on open heart and coronary artery bypass surgery, in which the American Society of Anesthesiologists (ASA) score was significantly associated with SSI, but gender was not. This study suggests that risk stratification in the JANIS system might be improved by incorporating additionally identified factors for risk adjustment, when comparing the incidence of SSI between hospitals.Key words: Bloodstream infections, epidemiology, hospital-acquired (nosocomial) infections, Staphylococcus aureus, surveillance